Steigerung der kardiopulmonalen Belastbarkeit durch Embolisation einer arteriovenösen Lungenfistel

Abstract

A 21-year-old woman suffering from increasing dyspnoea on intense physical exercise, was found to have a congenital right-sided arteriovenous pulmonary fistula. This was successfully and without complication embolized using a percutaneously introduced Gianturco wire coil. All symptoms disappeared after this procedure. Definite improvement in physical performance, in comparison with pre-embolization values, was documented by spiroergometry as early as two days later (oxygen uptake 1855 vs. 1459 ml/min; anaerobic threshold 920 vs. 790 ml/min; oxygen-pulse 10.6 vs. 8.0 ml/beat; oxygen partial pressure 77.5 vs. 67.6 mmHg; alveolar arterial oxygen difference 33 vs. 44 mm Hg). Further constant subjective and objective improvement in physical performance was demonstrated 3 months after embolization. This case confirms that embolization of a pulmonary arteriovenous fistula can rapidly achieve lasting improvement in exercise performance.

Surgical and Transcatheter Closure of Right Pulmonary Artery to Left Atrial Fistula

“…In the 2000s, the operative mortality has approached zero. In recent years, transcatheter closure has been introduced with favorable results 3,4,6,10,17, 21,31,32 . Our treatment of choice reflects the evolution of techniques and the accumulation of experience with this rare anomaly.…”

“…In the nine patients undergoing successful transcatheter closure, six belong to type I, one belongs to type II, and the type of the rest two is unspecified. Among them, four received an Amplatzer duct occluder, 4,6,17,32 two received an Amplatzer septal occluder, 10 two received a Gianturco coil, 21,31 and one received an Amplatzer muscular ventricular septal occluder 3 . Some have also reported use of a catheter approach either as a guide to surgical ligation, 18 or in combination with surgical closure 9 .…”

“…In recent years, transcatheter closure has been introduced with favorable results. 3,4,6,10,17,21,31,32 Our treatment of choice reflects the evolution of techniques and the accumulation of experience with this rare anomaly. When we operated on the first patient in 2000, due to a lack of previous experience of transcatheter closure, we chose to close the fistula under cardiopulmonary bypass lest technical difficulties and pulmonary venous anomalies were encountered.…”

“…Since Dr. Blalock performed the first surgical operation to ligate a RPA to left atrial fistula in July 1948, 29 surgical closure has been the treatment of choice until the introduction of transcatheter procedures to occlude these fistulas 21,31 . The reported mortality rate of those undergoing all types of surgical repair was high in the early years, and most surgical mortality occurred with operations done between 1950 and 1979 1 .…”